Primary Health Care Centers Research Articles

Developing a simplified measure to predict the risk of autism spectrum disorders: Abbreviating the M-CHAT-R using a machine learning approach in China.

Early screening for autism spectrum disorder (ASD) is crucial, yet current assessment tools in Chinese primary child care are limited in efficacy. This study aims to employ machine learning algorithms to identify key indicators from the 20-item Modified Checklist for Autism in Toddlers, revised (M-CHAT-R) combining with ASD-related sociodemographic and environmental factors, to distinguish ASD from typically developing children. Data from our prior validation study of the Chinese M-CHAT-R (August 2016-March 2017, n = 6,049 toddlers) were reviewed. We extracted the 20-item M-CHAT-R data and integrated 17 sociodemographic and environmental risk factors associated with ASD development to strengthen M-CHAT-R's machine learning screening. Five feature selection methods were used to extract subsets from the original set. Six machine learning algorithms were applied to identify the optimal subset distinguishing clinically diagnosed ASD toddlers from typically developing toddlers. Nine features were grouped into three subsets: subset 1 contained unanimously recommended items (A1 [Follows point], A3 [Pretend play], A9 [Brings objects to show], A10 [Response to name] and A16 [Gazing following]). Subset 2 added two items (A17 [Gaining parent's attention] and A18 [Understands what is said]), and subset 3 included two more items (A8 [Interest in other children] and child's age). The top-performing algorithm resulted in a seven-item classifier of subset 2 with 92.5 % sensitivity, 90.1 % specificity, and 10.0 % positive predictive value. Machine learning classifiers effectively differentiate ASD toddlers from typically developing toddlers using a reduced M-CHAT-R item set. This highlights the clinical significance of machine learning-optimized models for ASD screening in primary health care centers and broader applications.

Reliability and Validity of the Consultation and Relational Empathy (CARE) Scale.

The patient's perception of physician empathy has a positive influence on patient behavior and treatment effects. The scale of Consultation and Relational Empathy (CARE) scale has been widely used to measure patients' perceptions of doctor empathy. However, the CARE scale lacks a standardized Mandarin version. In this study, we developed a Mandarin version of the CARE scale and validated its quality. There were 341 patients with hypertension and/or diabetes from four primary healthcare centers in Zhejiang Province, China participated in the primary test. Exploratory factor analysis (EFA) was conducted to explore the underlying structure of the scale. Furthermore, the test-retest reliability of the scale was evaluated during this phase. A total of 1085 patients from six primary-level clinics participated in the secondary test. Confirmatory factor analysis (CFA) was employed to confirm the underlying structure of the scale. The analysis result demonstrated that the Mandarin version of the CARE scale comprises 10 items and 3 dimensions. In the secondary test, the overall Cronbach's α of the scale was 0.91, and the CRs of the 3 dimensions were 0.90, 0.90, and 0.88, respectively, indicating acceptable Internal consistency reliability and composite reliability (CR) of the scale. The average variance extracted (AVE) ranged between 0.65 and 0.79, and all square root values of the AVE for the three dimensions were higher than their Spearman correlations, indicating the good convergent and discriminant validity. The scale could serve as an evaluation tool for patients' perceptions of doctors' empathy in primary-level medical service settings in Chinese mainland.

Innovations in primary healthcare in Slovenia 2011-2020: Exploring the stepwise process behind effective implementation.

Countries worldwide seek to strengthen their primary healthcare systems often through introducing health promotion and disease prevention, multidisciplinary teams, group practices and community approaches to advance universal health coverage. These strategies are underpinned by scientific evidence and international standards. Slovenia's primary healthcare system reflects many of these features, with universally accessible, multidisciplinary, and integrated health services, emphasizing health promotion, disease prevention, and equity. Municipal primary healthcare centres serve as hubs within local communities. Slovenia's efforts to strengthen the delivery model are continuous and follow a controlled stepwise implementation process. This approach has strong policy support and organizational and implementation capacities. This paper describes Slovenia's primary healthcare model and three innovations between 2011 and 2020: (1) family medicine model practices, (2) health promotion centres, and (3) mental health centres. These innovations are used both to showcase the efforts of Slovenia to enhance primary healthcare and as a lens to explore Slovenia's established primary healthcare innovation implementation approach. The three innovations have had a positive impact on health outcomes in the short- to medium-term, but mixed health system and implementation outcomes. Slovenia's experience can inspire other countries looking to sustainably integrate primary healthcare fully or effectively introduce single innovations in their primary healthcare systems.

Automated and code-free development of a risk calculator using ChatGPT-4 for predicting diabetic retinopathy and macular edema without retinal imaging

BackgroundDiabetic retinopathy (DR) and macular edema (DME) are critical causes of vision loss in patients with diabetes. In many communities, access to ophthalmologists and retinal imaging equipment is limited, making screening for diabetic retinal complications difficult in primary health care centers. We investigated whether ChatGPT-4, an advanced large-language-model chatbot, can develop risk calculators for DR and DME using health check-up tabular data without the need for retinal imaging or coding experience.MethodsData-driven prediction models were developed using medical history and laboratory blood test data from diabetic patients in the Korea National Health and Nutrition Examination Surveys (KNHANES). The dataset was divided into training (KNHANES 2017–2020) and validation (KNHANES 2021) datasets. ChatGPT-4 was used to build prediction formulas for DR and DME and developed a web-based risk calculator tool. Logistic regression analysis was performed by ChatGPT-4 to predict DR and DME, followed by the automatic generation of Hypertext Markup Language (HTML) code for the web-based tool. The performance of the models was evaluated using areas under the curves of receiver operating characteristic curve (ROC-AUCs).ResultsChatGPT-4 successfully developed a risk calculator for DR and DME, operational on a web browser without any coding experience. The validation set showed ROC-AUCs of 0.786 and 0.835 for predicting DR and DME, respectively. The performance of the ChatGPT-4 developed models was comparable to those created using various machine-learning tools.ConclusionBy utilizing ChatGPT-4 with code-free prompts, we overcame the technical barriers associated with using coding skills for developing prediction models, making it feasible to build a risk calculator for DR and DME prediction. Our approach offers an easily accessible tool for the risk prediction of DM and DME in diabetic patients during health check-ups, without the need for retinal imaging. Based on this automatically developed risk calculator using ChatGPT-4, health care workers will be able to effectively screen patients who require retinal examinations using only medical history and laboratory data. Future research should focus on validating this approach in diverse populations and exploring the integration of more comprehensive clinical data to enhance predictive performance.Graphical

P-1725. A Cluster Randomized Trial of Bundled Interventions to Reduce Inappropriate Antibiotic Use in the Outpatient Setting

Abstract Background Antibiotics are often inappropriately prescribed in the outpatient settings. Among the most common reasons for inappropriate antibiotic prescriptions are upper respiratory tract infections (URI) which are known or highly likely to be viral in origin. Our aim was to test a bundle of complementary interventions to reduce inappropriate antibiotic prescriptions in the outpatient setting for patients presenting with various URIs. Here we present preliminary data from the cluster randomized trial using pre-intervention baseline data (August to October 2023) and after implementation of interventions (December 2023 to March 2024).Figure 1.Comparison of inappropriate antibiotic prescriptions for URTIs between the intervention and control groups during the pre-intervention (Aug 2023 – Oct 2023) and post-intervention phases (Dec 2023 - Mar 2024). Methods We randomly assigned 2 Primary Healthcare Centers (PHCC) in Qatar to receive a 4 component intervention: 1) extensive provider education; 2) providing an algorithm driven decision support tool based on professional society recommendations for appropriate use of antibiotics for various URIs; 3) option for deferred prescription; and 4) monthly feedback to all physicians regarding their prescription patterns including anonymized comparison with their peers. Two PHCCs in the control group received a single intervention which was randomly chosen. For this study, we identified 4 common URIs for which professional society guidelines do not recommend use of antibiotics (acute bronchitis, acute laryngitis, common cold, influenza without mention of pneumonia). Prescriptions written and corresponding diagnoses were retrieved from the electronic medical records. Children < 2 years of age, and individuals with any immune compromising condition or medications were excluded.Table. 1Appropriate and Inappropriate use of antibiotics in URTIs Results A total of 7,246 antibiotic prescriptions were written for 4 included URIs during the study period. The percentage of inappropriate prescriptions in the intervention group decreased from 67.7% to 62% in the first 4 months after the intervention (p-value >0.05). The proportion of inappropriate prescriptions in the control groups remained steady at 70% before and after the intervention. Conclusion While not statistically significant in this early stage, our preliminary results indicate a trend in reduction in inappropriate prescriptions of antibiotics for URIS in the outpatient setting. Disclosures Adeel A. Butt, MD, MS, Gilead Sciences: Grant/Research Support

DESAFIOS DA ASSISTÊNCIA FARMACÊUTICA NO SISTEMA ÚNICO DE SAÚDE (SUS) SOB O OLHAR DA ATENÇÃO PRIMÁRIA À SAÚDE

Pharmaceutical assistance within the Unified Health System (SUS) plays a central role in ensuring access to essential medicines and the effectiveness of public health actions, particularly in Primary Health Care (PHC), which serves as the main gateway to the system. This study aimed to investigate the challenges faced by pharmaceutical assistance in the SUS, with a focus on PHC, analyzing issues such as failures in distribution logistics, insufficient technical training of professionals, and poor integration between levels of care and information systems. Additionally, it addressed problems related to low patient adherence to treatment and the irrational use of medicines, factors that undermine the effectiveness of comprehensive care. The research was based on an in-depth literature review and employed qualitative methods to explore the complexity of pharmaceutical assistance management and the obstacles encountered in daily practice. Based on the identification of these challenges, recommendations were proposed for the formulation of more effective public policies, improvements in medication management, and enhanced training for health professionals. The study also highlights strategies to promote the rational use of medicines and optimize the quality of pharmaceutical care in PHC. It is expected that the findings will contribute to the improvement of pharmaceutical assistance within the SUS, ultimately strengthening the healthcare system as a whole.

Validity and Reliability Study of the Turkish Adaptation of the "Medical Office Survey on Patient Safety Culture".

The safety culture within health care organizations is essential for ensuring patient well-being and optimizing health care delivery. This study addresses the pressing need to establish a culture of patient safety within primary health care settings. The aim is to conduct a comprehensive validity and reliability study for the Turkish adaptation of the "Medical Office Survey on Patient Safety Culture" (MOSPSC) scale, designed to assess patient safety culture in primary care medical offices. The research model follows rigorous methodology, including a systematic translation and adaptation process aligned with World Health Organization guidelines. A diverse sample of 402 family physicians from primary health care centers across Turkey participated in the study. Descriptive results highlight participants' characteristics, work environments, and experiences in primary care. The scale's construct validity is evaluated using the Kaiser-Meyer-Olkin (KMO) and Bartlett tests, while its reliability is assessed through internal consistency analyses, including Cronbach α, split-half reliability, and item-total correlation. Results indicate strong internal consistency, with Cronbach α values ranging from 0.42 to 0.91 for scale dimensions and an overall value of 0.89. Construct validity assessment attests to the scale's appropriateness for assessing patient safety culture. Challenges in conducting factor analysis due to participant responses are discussed. The study contributes to the field by providing a validated and reliable tool specifically tailored for assessing patient safety culture in primary care medical offices. The Turkish adaptation of the MOSPSC scale offers health care professionals and organizations a valuable instrument for enhancing patient safety culture, identifying areas for improvement, and ultimately optimizing patient care within primary health care settings.

P-1724. Knowledge, Attitude, and Practices (KAP) on Appropriate Antibiotic Use among Healthcare Providers in Qatar - A cross-sectional study

Abstract Background There has been growing awareness of antibiotic resistance as a significant public health issue, notably a widespread prescription of antibiotics for upper respiratory tract infections (URTIs). Understanding the knowledge, attitude, and practices (KAP) of healthcare providers is crucial in designing interventions to reduce inappropriate antibiotics use. Our aim was to determine the KAP of primary care physicians towards antibiotics prescriptions in the outpatient setting to develop strategies to improve appropriate antibiotics use. Physician responses to KAP Survey. Methods We employed a cross-sectional survey to determine the KAP of physicians at 4 Primary Healthcare Centers (PHCCs) in Qatar. The KAP questionnaire was structured into three main sections: evaluating physicians' knowledge regarding Upper Respiratory Infections (URIs) and antibiotics, examining attitudes encompassing beliefs or perspectives on antibiotic usage for URIs, and investigating practices to understand how physicians implement their knowledge and attitudes in their actions. A 5-point Likert scale was used for the questions. Results A total of 141 physicians were surveyed and 96% responded. Nearly 80% were >40 years old, approximately half were women and 69% had ≥10 years of clinical experience. A majority of physicians (97.8%) agreed that inappropriate antibiotic use contributes to the rise of antibiotic resistance, 80.8% expressed disagreement with prescribing antibiotics for fever alone, and 40.4% admitted to experiencing patient pressure to prescribe antibiotics even when unnecessary. Conversely, 13.4% admitted to frequently prescribing antibiotics solely due to patient requests, and 37.6% confirmed encountering patient complaints or patient migration to other doctors if antibiotics were not prescribed. Conclusion Primary care physicians are knowledgeable about the role and risks associated with antibiotics, but frequently felt pressured by the patients/families to prescribe antibiotics. Intervention strategies to educate the public and empower the physicians are needed to address the inappropriate use of antibiotics. Disclosures Adeel A. Butt, MD, MS, Gilead Sciences: Grant/Research Support

Diagnostic Biochemical Changes Identified in a Cohort of Patients with Coronavirus-19 (COVID-19) Disease

Backgroun: SARS-CoV-2 infection was associated with inflammatory, metabolic, haematological, and immunological changes, which contributed to the increase in morbidity and mortality. Objective: To illustrate changes in some biomarkers (ESR, ferritin, CRP, D. dimer, ALT, AST, creatinine, and urea) during COVID-19 and their predictive value in the diagnosis of SARS-CoV-2 infection, especially in rural and urban areas in which sophisticated tests were not available. Materials and Methods: The study includes 154 COVID-19 patients with positive RT-PCR. Sixty age and sex-matched individuals were included as controls. The study was conducted during the period from 23rd July 2021 to the end of December 2021. The subjects with a history of liver diseases, pregnant women, an age of less than 18, and chronic renal failure were excluded. The informed consent was taken from each individual before their enrolment in the study. The study was performed in compliance with the World Medical Association Declaration of Helsinki. Venous blood samples were collected from both groups and tested for determination of creatinine, urea, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), D dimer, ferritin, and C-reactive protein (CRP) using a Mindray BS 240 chemical auto-analyzer. Results: The mean serum values were significantly higher (P= 0.01 – 0.001) in COVID-19 patients as compared to matched controls for creatinine, blood urea, ALT, AST, ESR, LDH, D- dimer, ferritin, and CRP. In addition, the mean serum levels of ALT, AST, ESR, LDH, D-dimer, ferritin, and CRP were higher than the values of normal ranges. Although, creatinine and urea mean serum values were significantly higher in COVID-19 patients, their mean values were within the normal range values. ESR was highly significantly (p < 0.001) correlated with ALT, AST, LDH, urea, ferritin, and CRP. While LDH was highly significantly correlated with creatinine, urea, ESR, ferritin, and CRP. Also, D. dimer was significantly highly correlated with ferritin, and CRP. Serum ferritin was highly significantly correlated with creatinine, urea, ESR, LDH, D. dimer, and CRP. While CRP was highly significantly correlated with creatinine, urea, ESR, LDH, D. dimer, and ferritin. Conclusion: ESR, CRP, Ferritin, D. dimer, LDH, AST, ALT, urea, and Creatinine levels in venous blood were significantly elevated in COVID-19 patients compared with controls. Sex- influenced serum levels of C-reactive protein, creatinine, and urea in this study cohort. Serum levels of tested biomarkers may be useful in the diagnosis of COVID-19 in primary healthcare centres, especially in rural areas in developing countries.

Optimizing the role of pharmacists at the primary healthcare centres in Indonesia through an integrated information system

IntroductionThe role of pharmacists at primary healthcare centers (PHCs) in Indonesia still needs long-term improvement. Enhancing interprofessional collaboration through data-driven collaboration is essential to strengthening cooperation. This study aimed to identify the need for an integrated information system to enhance the role of pharmacists at PHCs in Indonesia.MethodsA desk review was applied as the initial step to analyze the role of pharmacists at the PHCs in Indonesia. Furthermore, a qualitative study was conducted using Walt and Gilson’s health policy analysis framework. Semi-structured interviews were conducted in four sections (context, content, process, and actors) with consideration of selected key respondents. All interviews were transcribed verbatim and then analyzed using Braun and Clarke’s thematic analyses, ensuring a comprehensive understanding of the situation.ResultsWe identified two significant challenges in optimizing the use of integrated systems at the PHCs to increase the role of pharmacists. Considering context-content-process-actors, implementing integrated pharmaceutical care standards relies significantly on human resources and infrastructures. Key challenges related to human resources are a limited number of human resources, a high workload, and insufficient use of working tools. We found several challenges regarding infrastructure, such as network connectivity issues, non-integrated systems or applications, and suboptimal benefits from the current systems.ConclusionVarious systems or applications in PHC involve reporting to the Ministry of Health, but detailed integration of these systems needs to be achieved immediately. According to informants, the criteria for desired applications are crucial to optimizing the integrated system, using it, and streamlining tasks for pharmacists at PHCs. Common expectations include an integrated system for monitoring drug usage and orders. Apart from usefulness, network connectivity must be assured for accessibility by all parties.

Differences between private and public primary health care centers and differences between men and women in antihypertensive care and cardiovascular prevention in all patients with hypertension treated in primary care in Stockholm County, Sweden

AimsTo study differences in cardiovascular prevention and hypertension management in primary care in men and women, with comparisons between public and privately operated primary health care (PHC).MethodsWe used register data from Region Stockholm on collected prescribed medication and registered diagnoses, to identify patients aged 30 years and above with hypertension. Age-adjusted logistic regression was used to calculate odds ratios (ORs) with 99% confidence intervals (99% CIs) using public PHC centers as referents.ResultsIn total, 119,267 patients with a registered hypertension diagnosis at their primary care center were included; 58,239 men and 61,028 women. In terms of co-morbidities and medications, there were some differences between privately and publicly run PHC: registered diagnosis of dementia, which was higher at private PHC, age-adjusted OR 1.80 (1.24–2.69). For lifestyle counseling, privately run PHC had a higher rate of registered counseling for tobacco 1.17 (1.06–1.29), physical activity 1.13 (1.06–1.17), unhealthy diet 1.08 (1.04–1.13), and counseling according to highest prioritized level of advice stated by national guidelines 1.14 (1.09–1.18). Differences in comorbidities between men and women were found, with higher frequencies of coronary heart disease, congestive heart failure, atrial fibrillation, stroke, diabetes, and gout among men. Regarding antihypertensive treatment, women received less treatment of calcium channel blockers and ACE inhibitors, but more of angiotensin receptor blockers.ConclusionsThese findings highlight the need for targeted preventive efforts in PHC, especially for male patients, to address disparities in cardiovascular health outcomes. Small differences in preventive measures between public and privately run PHC suggest generally consistent care across healthcare ownership models.

Quality of life among healthcare workers in the hospitals and primary healthcare centers in Gaza Strip: a cross-sectional study

BackgroundQuality of life (QoL) is an important measure of overall well-being linked to physical, mental, social, and environmental aspects of health. This study aimed to assess the QoL among healthcare workers (HCWs) in hospitals and primary healthcare centers (PHCs) in Gaza Strip, Palestine.MethodsA cross-sectional study was conducted among 1850 HCWs in Gaza Strip, Palestine. Data were collected by using self-administered questionnaires in the paper-based format containing a sociodemographic profile and the World Health Organization Quality of Life Brief questionnaire. Factors associated with QoL were examined using an independent t-test, Chi-square test, and multivariate logistic regression models.ResultsThe study included HCWs with a mean age of 38.62 years old, of whom 61.9% were male. The mean QoL score was 55.98 (standard deviation: 11.50), with 55.5% reporting a good QoL. Multivariate logistic regression analysis revealed that age, smoking status, workplace, and work shifts were associated with the overall QoL score (p < 0.05). Older age (≥ 35 years), working in a hospital, and working the morning shifts were identified as protective factors for QoL, while smoking and working the evening-night shifts were inversely associated with QoL.ConclusionsThis study found that HCWs in Gaza Strip exhibited moderate levels of QoL. Age, smoking status, workplace, and work shifts were associated with overall QoL. Strategies to improve HCWs’ QoL, such as lifestyle interventions, additional support through training or educational programs, and reducing work schedules, could be considered under high-pressure situations.

Deep Learning-Based Detection of Ocular Surface Squamous Neoplasia from Ocular Surface Images

Purpose: Ocular Surface squamous neoplasia (OSSN) is a broad entity encompassing a spectrum of squamous neoplasms of conjunctiva and cornea. This study aims to explore the utility of Artificial Intelligence (AI) models in detecting OSSN from slit lamp (SL) images. Methods: This is a retrospective observational study. Slit lamp (SL) images of OSSN disease, non-OSSN ocular surface lesions (OOSD) and normal ocular surfaces (N) were collected (2013-2023). Images with minimum resolution of 1024 x 1024 pixels, under diffuse illumination were included. Data was divided into training and testing sets (85:15). Deep learning (DL) algorithms were applied for ternary classification of the SL images (OSSN, OOSD and normal). Three AI models - MobileNetV2, Xception and DenseNet121 were used in the study. A five-fold cross-validation strategy was utilized for robust model evaluation. Results: 163 images in OSSN group, 202 in OOSD group and 269 normal ocular surface images were included (n=634). Data augmentation was performed to increase and balance the data. The average accuracies for OSSN detection for DenseNet121, MobileNetV2 and Xception were 83%, 88.8%, and 84.5% respectively. MobileNetV2 and Xception had a similar average sensitivity for OSSN detection (74%) while MobileNetV2 was the most specific DL algorithm (96.25%) for OSSN detection. Conclusions: AI models showed good performance in image-based OSSN detection. AI models may provide a promising tool for OSSN screening in primary health care centers and for teleconsultation from remote areas in the future.

P1167 Treatable traits (TTs) approach in the management of Inflammatory Bowel Disease: a new concept

Abstract Background Inflammatory bowel diseases (IBD) are highly prevalent and complex chronic conditions that affect the digestive tract and induce extra-intestinal manifestations and numerous comorbidities. Distinct IBD phenotypes and clinical manifestations differ individually1. The pathogenesis of the disease is complex and requires personalized therapies2. The World Health Organization (WHO) recommends a holistic approach that is defined as "perfect physical, mental and social well-being." “Treatable traits" (TT) is a personalized and multidimensional precision medicine approach created primarily to deal with the complexity and heterogeneity of chronic and complex conditions. Initially proposed for treating respiratory diseases, it has expanded to other areas3. The present abstract aims to shed light on, identify, and define the most prevalent TTs applied to IBD. Methods TTs were identified according to their clinical relevance and the possibility of being modifiable, enabling personalized and individualized treatment targeting. They were subdivided into three main domains following the concept of TT in IBD. Adopting the TT concept will be useful in primary health care and tertiary centers to aim for disease control, avoiding exacerbations, and maximizing results, as demonstrated in other diseases4. Results Gastrointestinal or intrinsic TTs are composed of laboratory investigations (biomarkers), endoscopic and radiological, to identify the phenotypic characteristics and the degree of inflammatory activity. Extra-intestinal TT: The main ones are rheumatological, dermatological, ophthalmological, and hematological. It is important to emphasize that many of these extra-intestinal manifestations appear as comorbidities. Psychological and behavioral TT: based on the patient's lifestyle and behavior and include obesity and malnutrition, diet and nutrients, smoking, sedentary lifestyle and physical activity, sleep quality, fatigue, adherence to treatment, and family support network) as well as the mental health including anxiety, depression, and suicidal ideation. The list of treatable characteristics is limited by the knowledge of the interactions identified to date and will expand as they are identified and targeted treatments approved by ECCO. Conclusion The definition and identification of TT in IBD are feasible and reported for the first time. Treatment based not only on pharmacological treatment aimed at mucosal healing and improves to address the limitations of existing treatment strategies to date. The holistic approach proposed by the authors will benefit not only in improving patients' QoL but also in providing a more effective, sustained, and long-lasting response.

A perinatal psychiatry access program to address rural and medically underserved populations using telemedicine

BackgroundAlthough highly prevalent, most perinatal mental health and substance use disorders often go unrecognized, undiagnosed, and untreated. Perinatal Psychiatry Access Programs have emerged as a successful model to increase the capacity of front-line maternal health care providers to address perinatal mental health conditions through education, consultation, and increased resources and referrals.MethodsThis model has been adapted in South Carolina to include direct access to mental health treatment in response to inadequate maternity care and mental health services, including a large proportion of rural, Medically Underserved Areas in Primary Care and Mental Health Healthcare Provider Shortage Areas throughout the state. Moms IMPACTT [Improving Access to Perinatal Mental Health and Substance Use Disorder Care Through Telehealth and Tele-mentoring] leverages statewide partnerships and a virtual care model to provide: 1) people who are pregnant or within 1 year postpartum with immediate access by phone or internet to a clinician trained in perinatal psychiatric care coordination to assess and refer to an appropriate level of perinatal psychiatry services; 2) communication and care coordination with the person’s healthcare provider, as appropriate; and 3) healthcare provider training and real-time psychiatric consultation for the management and treatment of perinatal mental health and substance use disorders. Adaptations to this care model have demonstrated benefit including increase access to care for patients with perinatal mental health and substance use disorders and support for frontline health providers serving this population.ResultsWithin the first 12 months, the Mom’s IMPACTT program served people from 45 of the 46 counties in South Carolina. There were 938 encounters, 96% of which resulted in telehealth or teleconsultation with a care coordinator or program psychiatrist. Treatment was provided to 881 perinatal patients (54.6% White, 26.1% Black, 6.2% Hispanic) of whom 51.8% were insured by Medicaid, 89.7% resided in counties designed as fully Medically Underserved Areas, and 38.9% lived in counties designed as fully rural. Most calls were received directly from perinatal patients, with 60.7% (548/903) of patients requesting mental health support. Additionally, the program completed 22 consultations, and trainings with 443 healthcare providers throughout the state.ConclusionsAdaptations made to psychiatry access program evident in Moms IMPACTT appear to be successful in meeting the specific needs of birthing people in the state of South Carolina. Suggestions and considerations are included to replicate the success of Moms IMPACTT program elsewhere.

Teleconsultations in Primary Healthcare Centres During COVID-19 Pandemic and Its Aftermath

Teleconsultations in Primary Healthcare Centres During COVID-19 Pandemic and Its Aftermath

Generalised anxiety disorder and its determinants amongst patients with diabetes in primary healthcare clinics: a cross-sectional study in Kuwait City, 2024

BackgroundAnxiety disorders are the second most common mental health disorders in terms of disability-adjusted life years and years of life lost across all age groups. A bidirectional relationship between anxiety disorders and diabetes mellitus has been documented. This study aimed to determine the prevalence of anxiety and its associated factors among patients with diabetes receiving care at public primary care clinics in Kuwait during the first quarter of 2024.MethodologyA cross-sectional study was conducted in the first quarter of 2024 at three primary healthcare centres within the Capital Governate in Kuwait City. Adults with diabetes mellitus for longer than six months duration were requested to participate by the health promoters and the Generalised Anxiety Disorder questionnaire was shared via a mobile link/QR scan. Data were collected through self-or interviewer-administered surveys, cleaned and coded in Microsoft Excel, and analysed using STATA version 18. Descriptive analysis was initially conducted followed by bivariate and multivariate analysis with a p < 0.05 and a 95% confidence interval used to determine the association between demographic and clinical factors and GAD.ResultsA total of 554 patients participated, yielding an 80% response rate. Anxiety symptoms were observed in 48% of respondents, though only 4% (n = 25) had a GAD score > 10. Among participants with moderate-to-severe anxiety (n = 21), 52% were aged 50–59 years, 90% were non-native Kuwaiti citizens, and 62% had an HbA1C measurement > 7 mmol/L. Multivariate analysis indicated that non-native Kuwait citizens were significantly more likely to have moderate-to-severe anxiety (AOR: 6.99, 95% CI: 1.42–34.43) compared to Kuwaiti nationals. Conversely, participants attending clinic visits every two months were less likely (AOR: 0.30, 95% CI: 0.00–0.50) to report moderate-to-severe anxiety symptoms than those attending monthly.ConclusionWhile nearly half of patients with diabetes displayed anxiety symptoms, only a small proportion (4%) experienced moderate-to-severe anxiety. Non-native Kuwaiti residents were significantly more likely to have GAD scores > 10. Integrating anxiety screening into diabetes care may improve outcomes for this high-risk group.

Nurses’ experiences of text-based digital triage at primary healthcare centres in Sweden: a qualitative interview study

BackgroundTelehealth services are becoming increasingly popular at primary healthcare centres. Some examples include text-based digital triage and health guidance using chats, emails, images and pre-filled forms. Telephone-based communication has until recent years been the predominant means for triage and health guidance, but now includes written communication via computer or smartphone. Hence conditions to perform triage and health guidance have changed, which may affect the quality of nurses’ work and patient safety. This motivates an in-depth exploration of the consequences of such changes for nurses working with telehealth. The study aimed to explore nurses’ experiences of digital triage and health guidance at primary healthcare centres in Sweden.MethodsA qualitative inductive design was chosen for the current study. Four registered nurses and two public health nurses, working at primary healthcare centres in southern Sweden, contributed with information about text-based digital triage and health guidance. Semi-structured interviews were conducted to collect data. Data were analysed using qualitative content analysis.FindingsOne main theme, “Adapting to a new professional toolbox to triage and give health guidance” was constructed based on three categories which describe the altered professional tools. They were: “Using one’s senses differently to collect information”, “Change of communication mode to convey messages” and “Change of timeframe and the use of time”. Six subcategories describe how the new toolbox was experienced by the nurses. They were: “Loss of clinical ear”, “Gain of viewing images”, “Difficulties in written communication of care and emotions”,“Seeing oneself as a writer or talker”, “Tardy asynchronous communication” and“Available time”. ConclusionThe findings tell of a substantial change in nurses’ professional toolbox that demanded other skills than they were used to working with. Due to limitations in communication and communication skills, digital triage alone may lead to an impaired workflow, quality of care, and patient safety as well as maintain the digital divide. However, digital triage may also enhance nurses’ work with the addition of attached images, convenient communication for those who are comfortable with writing, and a gain of time for consultation and reflection. The current study contributes insights regarding new competencies that nurses and patients must have or gain to be able to benefit from the possibilities of digitisation of primary healthcare.

Assessment of Cognitive Functions in Multimorbid Patients in Lithuanian Primary Care Settings: A Cross-Sectional Study Using MMSE and LT-GPCOG.

Background and Objectives: The aging population has led to a rise in cognitive impairments, including dementia, often associated with multimorbidity. Early diagnosis of cognitive decline is crucial, especially in primary care, where time constraints and the limitations of diagnostic tools may hinder accurate detection. This study aims to assess the cognitive functions of multimorbid patients using the Mini-Mental State Examination (MMSE) and the Lithuanian version of the General Practitioner Assessment of Cognition (LT-GPCOG). We hypothesized that the LT-GPCOG would perform similarly to the MMSE in suspecting cognitive impairments. Materials and Methods: This cross-sectional study, conducted from 2021 to 2022, included 796 patients aged 40-85, with arterial hypertension and at least one other chronic disease, recruited from seven Lithuanian primary health care centers. Cognitive function was assessed using the MMSE and LT-GPCOG, and statistical analyses were performed using SPSS to determine the association between cognitive impairment and various demographic and clinical variables. Results: Out of 796 participants, 793 completed the study. Cognitive impairment was suspected in 5.1% of participants based on MMSE and 4.2% based on the LT-GPCOG. Statistically significant associations were found between cognitive impairment and chronic obstructive pulmonary disease (COPD) (p = 0.008 and p = 0.003) in both tests and chronic kidney disease (CKD) (p = 0.005) while testing with the MMSE. Lower education and unemployment were also correlated with cognitive impairment (p = 0.008 and p < 0.001). Conclusions: The findings suggest that regular cognitive assessments should be integrated into the management of multimorbid patients, particularly those with COPD and CKD. The LT-GPCOG proved to be an efficient alternative to the MMSE in primary care settings, demonstrating comparable diagnostic accuracy. Further studies are also needed to assess the sensitivity and specificity of the LT-GPCOG test.

Costs of outpatient services at selected primary healthcare centers in Bangladesh: A cross-sectional study.

Upazila Health Complexes (UzHC) serve as the backbone of primary healthcare (PHC) at the sub-district level in Bangladesh, delivering comprehensive healthcare services including both inpatient and outpatient services to the grassroots levels. However, not all the prescribed medicines and diagnostics services are always available at these facilities for outpatient care. This results in out-of-pocket expenditure (OOPE) to the patients for getting prescribed medicines and diagnostics services which has not been properly explored. Thus, we aimed to estimate the overall provider and user costs for outpatient care services at selected UzHCs in Bangladesh. An ingredient-based costing approach was applied to estimate the costs for the most commonly reported illnesses at outpatient of UzHCs from a societal perspective. We conducted a health facility survey at four purposively selected UzHCs to estimate provider costs and a patient exit survey among 452 patients of selected illnesses to estimate the user costs. Commonly reported illnesses were identified in consultation with healthcare providers of these facilities. The difference between costs of prescribed and provided medicines at UzHCs was estimated using the market prices. Data was collected between February to March 2021. The societal costs of the common outpatient illness or symptoms varied significantly, ranging from BDT 642 to BDT 1,384 per episode. Antenatal care had the highest cost burden at BDT 1,384, followed by respiratory illness at BDT 783 and urinary tract infection at BDT 670. On average, the provider spent BDT 289 for treating an outpatient, while a patient incurred BDT 446 as OOPE. Further, a patient was expected to spend an average of BDT 341 for purchasing medicines not provided from UzHCs. Our study found significant gaps between prescribed and provided medicines at UzHCs, leading to higher OOPE for patients. The current healthcare resource allocation strategy does not consider the outpatient load and healthcare demand at PHC facilities, which further exacerbates this gap. Addressing this gap requires a fundamental shift towards a demand-driven resource allocation model within the healthcare financing strategy to improve healthcare access and achieve health for all.